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Switiching from Imatinib to sprycel

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Hey everyone. I'm thinking of switching from Imatinib to Sprycel  Was on 600mg Imatinib for 2 years, then to 400 mg Imatinib for 2 years.  No blast cells.  6 months ago BCR-ABL was .350, 3 months ago .250   Will find out new numbers 9/11/2020.  Oncologist on board with switching drugs.  What dosage should I start with?  Oncology appointment 9/11/2020.  Thanks to everyone for such a great CML site.

 

Hi Ray,when I changed to Dasatinib my doctor said the standard dose was 100 mg but after reading  about people suffering with pleural effusions and other side effects I refused and said that would be too toxic for me .So my Doc agreed on 50mg but wasn't happy .New research says less is more but not all doctors keep up with research not even CML so called experts because I have had crossed words with a few of them.Well so far it's working for me and I am now on 40 mg much to their surprise .Your numbers are low so you could try 50mg if it doesn't work you can always go up better to start low first but it probably will .Dont be bullied it's your body and you don't want nasty side effects.Good Luck, Denise.

Thank you Denise.  Very good information for my upcoming visit. Ray

Hi,

My doc also wants me to switch to dasatinib from imatinib. However, when I read some papers I am not sure what advantage I can expect from it.

"However, while 2G and 3G TKIs present higher BCR-ABL1 inhibitory activity if compared to IM, they have failed to generate meaningful survival advantages for CML patients. Moreover, it is now apparent that, despite complete inhibition of BCR-ABL1 kinase activity, TKIs are unable to eliminate quiescent Leukemic Stem Cells (LSCs), as these cells are not “oncogene addicted” and therefore require alternative treatment strategies"

 

I have a bcrabl of 0,29% after 2 years, with 1 year on imatinib 600 instead of 400.

Argearge. Thank you. Seems my numbers plateaued. September 11 visit my numbers are.298 up from .250. I’ve made the decision to change. I asked for 50mg dosage. PA has to ok with oncologist. If my numbers were continuing to decline I probably would have stayed with imatinib.   Thank you for the reply

So you will start on 50mg ?

Keep me updated on how you are doing! I will make the change probably at the end of the month. I also want 50mg, but they advised me to take 140. I am not sure about that.

On the other side, being in CCyR is also fine. So staying on imatinib is, maybe, also an option. My haematologist has one patient on imatinib 400 for 11 years. Balancing between 0,1 and 1% bcrabl. No MMR.

Hey Denise, got my 50mg Sprycel yesterday.  Had no idea the VA in Boise Idaho have their own oncology pharmacist. He called, we had a great visit. He was stuck on the 100mg recommended dosage. Reluctantly said he would do 70mg.  I wasn't insistant, but asked him to review studies on 50mg starting dosage.  He is very knowledgeable about CML. I asked why he had so much knowledge and he said it interested him and he had studied it. He said he would talk to oncologist about starting dosage, and would I be up for testing more often, and I said yes.  Boise oncologist asked pharmacist to pass on the info that they would refer me to OHSU oncology dept if I wanted to.  Thank you again and I will post BCR ABL numbers as I test.   Ray
 

Argearge,  I will start the 50mg Sprycel today.  Will update as I test.  Ray

Hi Ray,o great glad you got 50 mg .Hopefully it will work great for you .I take mine before bed round about the same time each night ,I believe it only stays in your body for about 5 hours unlike Imatinib which is much longer so more side effects.I hope you feel much better on this  .You May wake up with a bit of a headache for a few days but by the time you have had breakfast it should be gone .Touch wood I don't have any side effects as such now apart from old age tiredness and aches and pains ,hopefully it will be the same for you .Good Luck would love to know how you are getting on with it .Regards ,Denise.

 

Ray - keep us posted as you test. Will be interesting to see your PCR numbers drop from current levels while taking 50 mg dasatinib.

Testing monthly during your transition from imatinib to dasatninib is wise. Also - should your PCR plummet - (I have a suspicion it will), consider lowering dose further to 20 mg. You will minimize side effects - including side effects you do not necessarily feel and you will keep your immune system stronger as well. You can always increase dose should PCR not fall.

In my case, my doctor did not gradually drop my dose. He started me at 70 mg (never 100) which only lasted a week. When I restarted dasatnib, he restarted me at 20 mg. because of his knowledge and experience with the drug. My PCR levels fell dramatically on that dose and I have been at that dose ever since (3 years 'undetected'). Now I take dasatnib 20 mg every other day weaning myself off it in preparation for complete cessation.

One other note - in terms of progression free survival or dying from CML. The gold standard is CCyR - complete cytogenetic remission. CCyR is zero CML cells observed under the microscope which corresponds approximately to 1.0% PCR. As long as a patient is CCyR, they have the same progression free survival statistics as patients in MMR (or undetected).

I will also give an update. I will probably switch to dasatinib this thursday ...

Argearge. Good luck to you sure hope it works 

Denise. Thank you, I to feel those aches and pains

Scuba. Your one of the main reasons I decided to switch. Thank you for your knowledge and positive support. 

Hi all,

I visited my haematologist today and there is no reason to switch meds yet. My PCR was 0,23% (3 months ago 0,29%)

He said if I continue to take Imatinib 600 I cannot stop meds, because I am stable at around 0,25% I cannot come deep enough with it. But patients do switch meds if they cannot tolerate the side effects and if the response is not acceptable. He said, I do not have that much side effects and the response is still acceptable. So his advise is to continue imatinib 600.

I gave him the literature about dasatinib 50mg and he is going to read it and discuss it at the following appointment in 3 months.

Hey Denise. What were your numbers prior to Dasatinib and after starting Dasatinib? My eyes are really swollen from imatinib, were yours?  If yours were swollen, did they go down?  I’ve been using eye lubricant and really helps.    I did have headaches Sunday through Wednesday.   None today.  The headaches were easily tolerated and didn’t last long.  A great day to you,  Ray

 

Argearge,  I was on 600mg imatinib for 27 months. Had 2 major side effects, diarrhea and muscle cramps. My BCR/ABL numbers when I changed to 400mg imatinib stayed the same. Regards Ray

Why did you start at 600mg ? My dose was increased to 600mg after 1 year 400mg to sub optimal response.

I really don’t know. No blast cells. At the beginning I never questioned anything. Was given no options. Wasn’t until I joined this forum, that I started learning and questioning , than God for this forum

Hi Ray,I was at 0.043% when I went on Dasatinib next blood after 3 months was 0.001% and after another 3 months was 0 yippee .Hope you have the same success ,and I touch wood I stay at 0.I had very hooded eyelids yes I didn't look like me I hated it ,but after only a few days they started going back to normal and I look like me again haha .I also had the dreaded rash this also cleared up right away  too ,the fatigue lessened and also the dreaded occasional diarrhoea went .I feel so much better on Dasatinib than Imatinib.Hope you feel better soon and I look forward to hearing about your journey on the downward trail ,Good Luck ,Denise.

Hi Denise, you were at 0.043% when you changed?. In another topic you wrote:

"Hi,I changed from400mg  Imatinib when I was at 0.4% to Dasatinib.Doc wanted me to start at 100 mg but I refused so I started on 50 mg .I reached Undetectable in less than five months ,I am now on 40 mg .You should be fine to play soccer ,the side effects of Dasatinib are nothing compared to Imatinib which for me were awful.It seems Dasatinib works differently to Imatinib so there should be some benefit ,Good Luck , Denise."

Hi, Long story .I was at 0.4% when I was put on Dasatinib blood had gone up because I was on antibiotics for an infected insect bite but they didn't tell me it had gone down to 0.043% because test result hadn't come back yet .They said bloods arnt affected by antibiotics but I proved they are so they panicked and made me changer to Dasatinib  and put me through another bone marrow test I didn't really need.Hope that makes sense.